2023 Women's Health Conference Registration Form

October 20 & 21, 2023

Live In-Person Activity

Marriot Pyramid North Hotel Albuquerque, NM


Please plan on completing the form in its entirety. This site cannot save your information for completion at a later date.


Prior to starting this form: Complete your UNM Tuition Remission paperwork, remember proper signatures are REQUIRED, complete your UNM PR and make a copy of your check, you will be required to upload a copy of these documents at the end of this form.


If you are a Medical Student proof of status IS REQUIRED. You will be required to upload a copy of your current class schedule showing you are a full time student. *Students will not receive professional credit.


CANCELLATION: If you cannot attend, CPL will refund tuition, less a $40.00 administrative fee provided it is received in writing on or before October 6, 2023. No refunds will be issued after this date or for non-attendance. Activities are subject to cancellation. In the event this activity is cancelled, CPL is not responsible for any airfare, hotel or other costs incurred by participants.

Contact Information

Prefix*

Ex: Gary, Dr. Smith, Gary Smith...

Provide all of your credentials. If medical student, list Medical Student.

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What type of address is this?*
Phone
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Number will ONLY be used on event day(s) if we need to reach you.

Registration Fees

Please select your registration code.

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Please select all that apply.

“Requesting Continuing Pharmacy Education Credit will be an additional $170 fee added to your registration.”


  • AMA PRA Category 1 Credits™ ($0.00)
  • Continuing Pharmacy Education ($170.00)
  • I don’t need credit ($0.00)

Please provide us with the DAY and MONTH of your birthdate.

Breakout Sessions

This conference will have 4 breakout sessions. Please select your first and second choice options for each session.


Minimum and maximum numbers have been established for these breakouts, you are not guaranteed your breakout until you receive your confirmation letter.


For more information on breakouts please view the conference brochure

Breakout Session 1: 1st Option*

Friday 10/20 9:45 am - 10:45 am

Breakout Session 1: 2nd Option*

Friday 10/20 9:45 am - 10:45 am

Breakout Session 2: 1st Option*

Friday 10/20 2:00 pm - 3:00 pm

Breakout Session 2: 2nd Option*

Friday 10/20 2:00 pm - 3:00 pm

Breakout Session 3: 1st Option*

Saturday 10/21 9:25 am - 10:25 am

Breakout Session 3: 2nd Option*

Saturday 10/21 9:25 am - 10:25 am

Breakout Session 4: 1st Option*

Saturday 10/21 3:00pm-5:00pm

Breakout Session: 2nd Option*

Saturday 10/21 3:00pm-5:00pm

Other Information

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We can not guarantee that a lunch will be available for any registrations after October 16th.


Your registration includes breakfast and lunch. Please let all that apply so we can provide accurate counts.

Please select which lunch session you will attend*
Do you have any dietary needs?*

Payment Method

Please select your payment method below. If you are using another payment option (Free registration, Scholarship, etc...) please select other and explain.

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Once you have submitted this form you will be automatically directed to our TouchNet payment portal. Please enter your payment information to complete your registration. If you do not complete the payment page your conference registration is incomplete. You will receive an email from TouchNet with your payment receipt once payment is received.

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Tuition Remission

Professional Development

Course: 2023 W+HC

Class Day/Time: October 20 & 21st, 2023

Cost:

Early Bird (9/28/2023)

MD/DO: $450.00

PA, RN, NP, CNM, Others: $350.00


Regular (9/29-10/17/2023)

MD/DO: $490.00

PA, RN, NP CNM, Others: $390.00


Onsite (10/18-10/21)

MD/DO: $515.00

PA, RN, NP, CNM, Others: $415.00


Information regarding Tuition Rates and the Taxability of Tuition Remission my be viewed at: http://bursar.unm.edu/index.html

Supervisory approval is required if any of the following apply:


  • A credit course taken during the employee's regular work schedule (approval is to authorize the absence from work and to approve an alternative work schedule): or
  • A non-credit professional development course taken during the employee's work schedule that is related to the employee's job or a UNM job to which the employee may reasonable aspire (approval is to authorize absence from work and approve an alternative work schedule): or
  • A non- credit health and fitness course taken during the employee's work schedule (approval is to authorize the absence from work and to approve an alternative work schedule).
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Employment Status *
Phone

Employee Certification

Please check the following statements, to indicate you acknowledge each.


Information regarding Tuition Rates and the Taxability of Tuition Remission my be viewed at: http://bursar.unm.edu/index.html

By electronically signing this document, I agree the following information I provided above is complete and accurate.

*Your conference registration is not complete until we have received your payment method.


If you are paying by check, a copy of the check MUST be uploaded here. Checks MUST be received by UNM CPL within 5 business days of completing this registration site. Please make checks payable to: UNM CPL 1 University of New Mexico MSC09 5370 Albuquerque, NM 87131-0001


If you are paying by UNM PR, a copy of the PR MUST be uploaded here.


If you are a Student please upload your current fulltime student schedule here. *This is a required field and you will not be able to finish this form unless you upload something.


If you are unable to upload the necessary information listed above please contact us at HSC-CPL@salud.unm.edu or 505-272-5166 for assistance.

Drag and drop files here or

Once you have submitted this form you will be automatically directed to our TouchNet payment portal. If you are paying with a credit card you MUST complete your payment in this portal. If you are not paying with a credit card your registration form is complete after you hit the submit button below and you can exit the TouchNet payment portal you are redirected to.

*Your conference registration is not complete until we have received your payment method.

Click Send me a copy of my responses below for a copy of your answers and as confirmation of your submission.

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